| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5501 |
For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe |
34 |
12 |
$4K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
84 |
70 |
$3K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
56 |
53 |
$2K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
73 |
64 |
$2K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
80 |
32 |
$2K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
25 |
25 |
$2K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
65 |
18 |
$952.74 |